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026-1001-90-020
Wisconsin Department of Commerce Count PRIVATE SEWAGE SYSTEM St. Croix Safety and Building Division INSPECTION REPORT Sanitary Permit No: 506256 0 GENERAL INFORMATION (ATTACH TO PERMIT) State Plan ID No: Personal information you provide may be used for secondary purposes [Privacy Law, s.15.04 (1)(m)]. Permit Holder's Name: City Village X Township Parcel Tax No: Derrick Construction Richmond, Town of 026- 1001 -90 -020 CST BM Elev: Insp. BM Elev: BM Descripti Section/Town /Range /Map No: 01.30.18.10A20 TANK INFORMATION ELEVATION DATA TYPE MANUFACTURER CAPACITY STATION BS HI FS ELEV. Septic Benchmark Dosing Alt. BM Aeration ` 1 c► r Bl Se wer 1 3. / Holding r l / St/Ht Inlet 6 `OO , r TANK SETBA I St/Ht Outlet NFORMATION a0 • - 2 . 7 7 TANK TO �P /L WELL BLDG. Vent to Air Intake ROAD Dt Inlet ! �_ Septic ' ri pf 0 Dt Bottom Dosing �/� �n , p, eader an. ` t S 1(0 .71 7 ! � Aeration Dist. Pipe 00 740.119 A q Holding Bot. System /b ' A. O / 6. 0 Final Grade PUMP/SIPHON INFORMATION 6. �f /a4• S Manufacturer Demand St Cover . b3 X0 - v GPM Model Numb Il Z TDH Lift Friction Loss Syst ead TDH Ft Forcemain Length Di Dis . well SOIL ABSORP N SYSTEM 0 CU 6 BED[TRENCH Width Length No. Of Trenches PIT DIMENSIONS No. Of Pits Inside Dia. Liquid Depth DIMENSIONS 3 3 SETBACK SYSTEM TO P/L 6 BLD WELL LAKE /STRE LEACHING nufactur INFORMATION CHAMBER OR pl ow Type/Of System: / t UNIT cdel Number: DISTRIBUTION SYSTEM 2 7 s .Slll< CE(�d $ i N► /D 44'c Header/ P D d Distribution �!r� F x Hole Size x Hole Spacing Vent to Air Intake h Pipes) Q' ��r�i`' 1 LengtM '� Dia Length OO Dia Spacing 3 'CAJ SOIL COVER x Pressure Systems Only xx Mound Or At -Grade Systems Only Depth Over IDepth Over xx Depth of xx Seeded /Sodded xx Mulched Bed/Trench Center Bed /Trench Ed es Topsoil 9 p ;Yes J No Yes No COMMENTS: (Include code discrepencies persons present, etc.) Inspection #1: / 26 1 Inspection #2: / / Location: 1735 140th St c.o�uw t New Richmond, WI 54017 (NW 1/4 SW 1/4 1 T30N R18W) Willow Valley Lot 6 Q . Parcel No: 01.30.18.10A20 1.) Alt BM Description = 2.) Bldg sewer length = 30'— -504 'f ( v 1W.CPd� 14, Z 'L�� 3 4Q - amount of cover =� it Plan revision Required? 0 Yes , No G� Use o side ide for additional information. l � -2 L::; ;`= ule Date Insepctor's Signat Cert. No. B -6710 R.3/97 S D ( ) I Generated by PDFKit.NET Evaluation comtltelCB.wi.goV Safety and Buildings Division county ., 201 W. Washington Ave., P.O. Box 7162 SAINT CROIX scO n S'' Madison, WI 53707 - 7162 Sanitary Permit Number (toe filled in b C o.) t (lope 4ce 56 Co 2 S Sanitary Permit Application State Transaction Number In accordance with s. Comm. 83.21(2), Wis. Adm. Code, submission of this forth to the e A4 governmental unit is required prior to obtaining a sanitary permit. Note: Application fo state - owned project A ddress (it different than mailing address ) POWTS are submitted to the Department of Commerce. Personal information you vid ay used for :• / 735 secondary purposes in accordance with the Privacy Law, s. 15. 1)(m), Stats. f� I. Application Information - Ple a All Inform Parcel # r'1 Property Owner's Name V W 1 026- 1001 -90 -020 WM DERRICK CONST INC. Property Location P roperty Owner's Mailing Address jUL I I CUU1 Govt. Lot 1505 HWY 65 P O BOX 445 NW `' /., SW '/4, sects f 1 C ity, to rp one Nttm r (circle one) NEW RICHMOND WI 5)246 -2320 T 30 N; R 18 EorW H. Type of Building (check all that apply) a k, a „ a pq ` # Subdivision Name I (*— C A'Q c� U 1 or 2 Family Dwelling - Number of Bedrooms 4 N,'// -e. Block # w v N O C Public/Commercial - Describe Use h. s o%a_ law I (_ City (' State Owned - Describe Use .3 „ W $ } ? g CSM Number t Village RICHMOND 9/2504 (a Township of III. Type of Permit: (Check only one box on line A. Complete tine B if applicable) A • (i New System (� Replacement System (` Treatment/Holding Tank Replacement Only (^ Other Modification to Existing System B. F Permit Renewal r Permit Revision Change of Permit Transfer to New List Previous Permit Number and Date Issued Before Expiration Plumber Owner IV. Type of POWTS System: (Check all that apply) Non - Pressurized In -Ground r Pressurized I,Ground r At -Grade r Mound > 24 in. of suitable soil i Mound < 24 in. of suitable soil r Holding Tank r Other Dispersal Component(explain) i Pretreatment Device (explain) O V. Dispersal/Treatment Area Information: .� Design Flow ( pd) Design Soil Application Rate(gpdsf) Dispersal Area Required (sf) Dispersal Area P sed (sf) System Elevation 600.00 ✓ 0.50 ,/ 1200.00 1200.00 96.00 VI. Tank Info Capacity in Total Number Manufacturer G Gallons Gallons of Units /' U °gy p N. Existing Tanks Talcs jjr/ / O / d sz �t a U inn o� N k �+ Septic or Holding Tank 1250 1250 1 Wieser Concrete Products ❑ r r F Dosing Chamber r r r F F VII. Responsibility Statement I, the undersigns same responsibility for installation of the POWTS shown on the attached plans. Plumber's Name (Print) LbeLls store MP/MPRS Number Business Phone Number CALVIN POWERS MPR #220537 (715)246 -5135 Plumes Address ( treet, City, State, Zip ode 1969 185th ave, New Richmond, WI 54017 VIII Coon Coon Use Only Approved (` rsapprove Sanitary Permit Fee (includes Groundwater Date Issuing nt Sign o Stem ) Surcharge Fce) -GL" . �� tven Reason fo enial �J 7 1X. Conditions of Approval/Reasons for Disapproval /� n ��- SYSTEM OWNEW, II 4 canto. fanir often f M or and AA � � . L -. • . ., n .��- K Aet.v + • , T � � • ,. Y f��Pyy Y iK .. �. r t: ,:. N��. .. z ., .. Y.�^ J:. �. ,.:;Rig � _. .d:; ._ .....� F )OT Y I Tao N K' CZ I :30 3 °Y r Y 1 � 1 I Owner. WiA DERRICK CONST INC. Bench Mark Description BENCHMARK �- AddW_W 15 5 HWY 65 P O BOX 4 SE CORNER OT STAKE BACKHOE PIT p Crty,State,Zip: N RICHMOND, WI 54017 AUG BORING a Drawn By. Calvin Powers ELEVATION A Address: 1969185th Street p OBS PIPE o CityState,Zip: New Richmond, WI 54017 VENT PIPE • Phone: {715)246 -5135 SCALE. i • = D WELL 0 Pal M I T N R fg N w Yy s I 3° oa rr � f I` p Owner Wo DERRICK CONST INC. Bench Mar Descriptio BENCHMARK Address 1 ckir. HWY 65 P O BOX 49 SE CORNER OT STAKE BACKHOE PIT p City,StateZIF NiETV RICHMOND, WI 54017 AUG BORING O Drawn %r Calvin Powers ELEVATION s OBS Address: 1969185th Street 0 VEN PIPE o CityState,rp: New Richmond, WI 54017 VENT PIPE • WELL Phone: (715)246 -5135 ScALE: I �=O 0 I Generated by PDFKit.NET Evaluation Wisconsin Department of Commerce SOIL EVALUATION REPORT Page 1 of 2 Division of Safety and Buildings in accordance with om 5, Adm. Code County SAINT CROIX Attach complete site plan on paper not less tha ze. Plan must include, but not limited to: vertical and horizontal reference point (BM), direction and Parcel I.D. 026 - 1001 -90 -020 percent slope, scale or dimensions, north arrow ce to nearest road. Please print all infonnedon Reviewed by Date Personal information you provide may be used for secondary purposes (Privacy Law, s. 15.04 (1) (m)). - 7 // d Property Owner RECEIV U Property Location WM DERRICK CONST INC. Govt. Lot NW 1/4 SW 1/4 s 1 T 30 N R 18 E (or) W Property Owner's Mailing Address J U L 1 1 Lot # Block # Subd. Name or C 1505 HWY 65 P O BOX 44 6 CSM #9/2504 1.57A City State Ziq Code 6WWr r (` City Village ( Tow Nearest Road NEW RICHMOND WI 54P17 (715)246-230 RICHMOND CTY RD GG & 140th t: New Construction Use: (i Residential / Number of bedrooms 4 Code derived design flow rate 600.00 GPD C Replacement C Public or commercial - Describe: Parent material TILL Flood Plain elevation if applicable N/A General comments and recommendations: F1 Boring # Boring 100.47 106 in (i pit Ground surface elev. ft Depth to limiting factor . Soil Appli ' ion Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPDtfb in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eft#1 I 'Eff#2 1 0-9 10YR4/2 sil 2fsbk mfr cs 2f 0.6 0.8 2 9-21 10YR5 /8 sil 2fsbk mfr cs if 0.6 0.8 3 21-51 7.5YR4/6 Is Omsbk mvfr gw 0.7 1.6 4 51-106 10YR5 /6 fs Ofsg ml 0.5 1 Comments: 2 Boring # Boring Pit Ground surface elev. ft. Depth to limiting factor 106 in (� Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fb in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Ef1#1 'Eff#2 1 0-7 10YR312 sil 2fsbk mfr cs 2f 0.6 0.8 2 7 10YR5/6 sil 2fsbk mfr cs if 0.6 0.8 3 22-55 7.5YR5/8 ) Is lmsbk ml gw 0.7 1.6 4 55-106 10YR5/6 r( Is 1 msg ml 0.7 1.6 It Comments: ' Effluent #1 = BOD ,> 30 < 220 mg/L and TSS >30 < 150 mg/L * Effluent #2 = BOD ,< 30 mg/L and TSS < 30 mg/L CST Name (Please Print) Signature n CST Number Calvin Powers l / 220537 Address Date Evaluation Conducted Telephone Number 1969 185th Street, New Richmond, WI 54017 6/6/2007 (715)246 - 5135 CHCK nere O unloCK l-'UF-KlT.NE -8330 (R07/00) Generated by PDFKit.NEt Evaluation Property Owner DERRICK CONST INC. Parcel ID # 026 - 1001 -90 -020 2 2 Page of BF oring Boring # pit Ground surface elev. ft. ft Depth to limiting factor 106 3 in a pp (canon Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/fts in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 1 0-9 10YR4 /2 sil 2fsbk mfr cs 2f 0.6 0.8 2 9-23 10YR5 /6 7 2fsbk mfr cs If 0.6 0.8 3 23-54 7.5YR4/6 Is lmsbk ml gw 0.7 1.6 4 54-106 10YR616 fs Ofsg ml 0.5 1 A %1 `d Comments: ❑ Boring # Boring (` pit Ground surface elev. ft. Depth to limiting factor in. Soil Application Rate Horizon Depth Dominant Color Redox Description Texture Stricture Consistence Boundary Roots GPD/ftz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. 'Eff#1 'Eff#2 Comments: ❑ Boring # C` Boring (� Pit Ground surface elev. ft. Depth to limiting factor in. Soil Applicaton Rate Horizon Depth Dominant Color Redox Description Texture Structure Consistence Boundary Roots GPD/ffz in. Munsell Qu. Sz. Cont. Color Gr. Sz. Sh. *Eff#1 'Eff#2 Comments: ' Effluent #1 = BOD 5 > 30 < 220 mg/L and TSS >30 < 150 mg /L * Effluent #2 = BOD 5< 30 mg/L and TSS < 30 mg/L The Department of Commerce is an equal opportunity service provider and employer. If you need assistance to access services or need material in an alternate format, please contact the department at 608- 266 -3151 or TTY 608 - 2648777. SBD- 8330Test (R.07 /00) Click here to unlock PDFKit.NET Genertiled by FDFKit.NF -. ' Evai'uation So c4 gj f lbrt 1 i 1 l a lei S&4 Lort ,C i nQ aS ' 3 3 Owner WM DERRICK CONST INC. Bench Mark Description BENCHMARK A Address: 1505 HWY 65 P O BOX 44 SE CORNER OT STAKE BACKHOE PIT p CillStateZIIx NEW RICHMOND, WI 54017 AUG BORING o Drawn By: Calvin Powers ELEVATION s Address: 1969185th Street 0 OBS PIPE o CityState,Zp: New Richmond, WI 54017 VENT PIPE 0 Phone: (715)246 -5135 SCALE: i • _ WELL O z a 3 L � w o a m v 0 _ v�c�i w Z x Iq o Ln u1 v1 0+ I = m 0 `^ d H C N C C ^ Gi 7 8 v O LU 0 o L w °vC a rnv v O W S a Z p a O L_ N 0^ J J Y V1 O CL LLJ O _ V_ LU v p = Ln Y + f o o W Z IS z - Q) o. - w rn C7 v IV W Of v m N c D ~ 3 > ( > v ; � D O QU LJJ _ F 0 0 u.. a) y A 3- L 3 O 20 > 0. n a -° � o O o ° a L L I_- w z OD N F- o LA 90 N X N vOvio J Li z ec J Z - ' R VV o w 0 / z Z J o w s l� u 3 O �w v ia Of w ° s •' ° o m a w U ; a Ir U N IL z Z N C z o LV $ O P: LLI H E c V)W O _� Z U iT O N m ` LM a N O w C C w w Z d OD v z '::k �'�; c OC N Y > % Y �rnm LL. LL y V Z D a 1 a_ m iri m c� o �- 0¢Ua s = Y � U (� U Generated by PDFKit.NEt Evaluation CONVENTIONAL SYSTEM USER'S MANUAL PROJECT: 1505 HWY 65 P 0 BOX 445 SYSTEM START -UP For new construction, prior to the use of the POWTS, check the treatment tank(s) for the presence of painting products, chemicals or other foreign objects not being a part of the POWTS that may impede the treatment process and/or damage the dispersal cell(s). If high concentrations are detected, have the contents removed by a septage servicing operator prior to use. Additionally, system start-up shall not occur when soil conditions are frozen at the infiltrative surface. SYSTEM OPERATION A conventional in- ground septic system consists of a septic tank and a subsurface soil absorption cell (see plot plan). In the septic tank, solids settle out of the waste stream and anaerobic bacteria facilitate the partial breakdown of organic matter (primary treatment). Clarified effluent from the septic tank discharges via gravity flow through an effluent filter to the soil absorption cell. The soil absorption cell removes pathogens, organic matter, and suspended solids from the septic tank effluent via physical filtration, biological reduction of contaminants by aerobic microorganisms, and ion bonding to negatively charged day particles (secondary treatment). The soil serves as a fixed porous medium on which beneficial microorganisms gram. These organisms feed on organic matter present in the wastewater and help eliminate pathogens. Three feet of suitable soil between the distribution cell and bedrock or high groundwater is sufficient to protect public health and groundwater quality. This system type requires about five feet of suitable native soil. The conventional system is a passive system that relies on gravity flow. The flow volume entering the septic tank controls the volume discharged to the soil absorption cell. The effectiveness of a conventional system depends on the type and permeability of native soils and the slope and drainage pattern of the site. The septic tank requires periodic pumping as determined by State and County Code, as well as inspection of the soil absorption cell. the effluent filter component also requires periodic maintenance. MANAGEMENT & CONTINGENCY PLAN This Private Onsite Wastewater Treatment System ( POWTS) has been designed, and is to be installed and maintained according to Comm 83, WI Admin. Code, the Conventional Soil Absorption Component Manual for ( POWTS SBD- 10706 -P; Jan 30 2001) (, and the POWTS owner's County Private Sewage System Ordinance. This POWTS has been designed to accommodate a maximum daily flow of 600.0 gallons of domestic waste per day. The quality of influent discharged into the POWTS treatment or dispersal component shall be equal to or less than all of the following: ** a monthly average of 30 mg/L fats, oil and grease ** a monthly average of 220 mg/L BOD(5) ** a monthly average of 150 mg/L TSS Wastewater shall not be discharged to the POWTS in quantities or qualities that exceed these limits or that result in exceeding the enforcement standards and preventative action limits specked in ch.NR140 Tables 1 & 2 at a point standards application, except as provided in Comm 83.03(4), WI Admin. Code. The owner of this POWTS is responsible for system operation and maintenance. The following maintenance shall occur within three (3) years of the date of installation and at least once every three years thereafter. 1) The septic tank(s) (and pump chamber if applicable) shall be pumped by a certified septage servicing operator, licensed under s.281.48, WI Stats, unless inspection by a licensed master plumber or person authorized to make such inspection, finds less than one -third (1/3) of the tank volume occupied by sludge and scum. More frequent pumping may be necessary to prevent solids from exceeding 113 of the volume of the tank. Wastes shall be disposed of by the pumper in accordance with ch. NR113, WI Admin. Code. At each pumping, the pumper must visually inspect the condition of the tank, baffles, risers and manhole cover and verify that any required locks are present. Please note that owner must provide septage servicing operator with reasonable access to tank(s). This may include (but is not limited to) construction of a designated drive or servicing pad to within 150 horizontal feet and /or to within 15 vertical feet to bottom of the tank(s), foot traffic over and through property, or vehicle traffic over and through property. 2) The soil absorption component(s) shall be visually inspected by a licensed master plumber, certified septage servicing operator or POWTS inspector. Inspection shall check for evidence of discharge of sewage to the ground surface and for ponding of effluent in the distribution cell(s). 3) The tank filters) shall be inspected and cleaned to remove any accumulated solids according to the manufacturdes specifications. The filter cartridge shall not be removed unless provisions are made to retain solids in the tank. Cleaning of the filter at more frequent intervals may be necessary. 4) Any pump, alarm or related electrical connections shall be visually inspected for defects and tested to confirm that they Click here to unlock PDFKit.NET Generated by PDFKit.NEt Evaluation are operating properly. (if applicable) 5) Reports for all system maintenance shall be submitted to the County Government in which the POWTS is located in accordance with Comm 83.55 WI Admin. Code and the County's Private Sewage Systems Ordinance. No one should enter a septic or other treatment tank for any reason without being in full compliance with OSHA standards for entering a confined space. The atmosphere within these tanks may contain lethal gases, and rescue of a person from the interior of the tank may be difficult or impossible. No product for chemical or physical restoration or chemical procedures for POWTS may not be used unless approved by the Department of Commerce in accordance with Comm 84, WI Admin. Code. In the event that this POWTS or a component of this POWTS fails and cannot be repaired, replacement of the POWTS or the component shall occur in accordance with WI Admin. Code and the County's Private Sewage Systems Ordinance that is in affect at the time of the failure. If this POWTS is replaced and its use discontinued, it shall be abandoned in accordance with Comm 83, WI Admin. Code. Any component failure, defects, or malfunctions identified during maintenance described on the previous pages shall be repaired in conformance with Comm 83, WI Admin. Code, and the County's Private Sewage Systems Ordinance. Below, in addition to the regulating agency, is a list of names and telephone numbers of the properly licensed individual(s) to contact for such repairs. County Office: SAINT CROIX REGULATORY AGENCY: Address: 1101 Caffnichael Rd. City St Zip Hudson, WI 54016 Phone: 715-386 -4680 Name: CALVIN POWERS INSTALLER: Address: 1969185th ave City St Zip New Richmond, WI 54017 Phone: (715)246 -5135 Name Calvin Powers POWTS DESIGNER: Address: 1969185th Street City St Zip New Richmond, WI 54017 Phone: (715)246 -5135 Name: Wieser Concrete Products TANK MANUFACTURER: Address: 2815 Riley Road City St Zip Portage, WI 63901 Phone: 800 - 362 -7220 Name: EZ-Flow ABSORPTION CELL MFR.: Address: 65 Industrial Park City St Zip Oakland, TN 38060 Phone: 800 - 649 -0253 Name: Polylok, Inc. EFFLUENT FILTER MFR.: Address: 4003 Capital Drive City St Zip Wallingford, CT 06492 Phone: (203) 265 -6340 Click here to unlock PDFKit.NET ST. CROIX COUNTY SEPTIC TANK MAINTENANCE AGREEMENT AND OWNERSHIP CERTIFICATION FORM Owner/Buyer _ 1�1 p r n iS:. l ,� �c�`r n 60\ T nn �A. Mailing Address I a S�Q S 1°© a_� N •�, �:� c Ctrl Sc�v l� Property Address 17 3.5 14 (Verification required from Planning & Zoning Department for new construction.) City /State N a , , - C Parcel Identification Number ba (0 , f w 6_ LEGAL DESCRIPTION i Property Location NO %a , s3' a ,Sec. T QN R_tl� W, Town of C 0 n d. Subdivision w L Lot # �. Certified Survey Map # , Volume -! , Page # Warranty Deed # SSa3 , Volume Page # Spec house yes no Lot lines identifiable (l�) no SYSTEM MAINTENANCE AND OWNRR CERTIFICATION improper use and maintenance of your septic system could result in its premature failure to handle wastes. Proper maintenance consists of pumping out the septic tank every three years or sooner, if needed, by a licensed pumper. What you put into liar system can affect the function of the septic tank as a treatment stage in the waste disposal system. Owner maintenance responsibilities are specified in §Comm. 83.52(1) and in Chapter 12 - St Croix County Sanitary Ordinance. The property owner agrees to submit to St. Croix County Planning & Zoning Department a certification form, signed by the owner and by a master plumb". journeyman plumber, restricted plumber or a licensed pumper verifying that (1) the on -site wastewater disposal system is in proper operating condition and/or (2) after inspection and pumping (if necessary), the septic tank is less than 1/3 full of sludge. Uwe, the undersigned have read the above requirements and agree to maintain the private sewage disposal system with the standards set forth, herein, as set by the Department of Commerce and the Department of Natural Resources, State of Wisconsin. Certification stating that your septic system has been maintained must be completed and returned to the St. Croix County Planning & Zoning Department within 30 days of the three year expiration date. Uwe certify that all statements on this form are true to the best of mylour knowledge. Uwe amlare the owner(s) of the property described above, by virtue of a warranty deed recorded in Register of Deeds Office. Number of bedrooms Z / 3 / SIGNATURE OF APPLICANTS) DATE ** *Any informadon that is misrepresented may result in the sanitary permit being revoked by the Planning & Zoning Department. * #* Include with this application a recorded warranty deed from the Register of Deeds Office and a copy of the certified survey map if A wence is made in the warranty deed. (REV- osros) Generated by PDFKit.NET' Evaluation POWTS INDEX (Private On -Site Waste Treatment System Index) Project Owner Name & Address Parcel ID Number WM DERRICK CONST INC. 026 -1001 - 90-020 1505 HWY 65 P O BOX 445 ' County NEW RICHMOND, WI 54017 SAINT CROIX Project Street Location Legal Description E CTY RD GG & 140th NW 1/4 SW 1/4 Sec. 1 T 30 R 18 W u mitter Return By Mail Lot Block Request: ❑ Call For Pickup 6 E] Return By E -Mail Subdivision C Type of System & Component Manual Utilized: CSM #9/2504 1 .57A 0 Mound (version 2) SBD- 10691 -P & SBD- 10706 -P (N. 01101) (0 Town Holding Tanks SBD 10571 -P (R. 06/99) [!fl In -Ground (version 2) SBD 10705 -P (N. 01/01) C city RICHMOND I3 At -Grade SBD 10570 -P (R. 6/99) (� Village 0 Other Petition for Variance & Individual Site Design CONTENTS F or official use only Page# Description 1 INDEX 2 Plan Design 3 Cross Sections 4 Site and Soil Evaluation 5 User's Manual n/a Vicinity Map Attachment: SBD -6398 Attachment: STMA (if required) esigne lumber. I the undersigned, hereby certify that the plans and specifications submitted herewith were prepared under my CALVIN POWERS direction and control. 1969185th ave & SEj°'L: 1969185th ave, New Richmond, WI 54017 Calvin Powers Drawn By: 1969185th Street New Richmond, WI 54017 Click here to unlock PDFKit.NET Generated by PDFKit.NET Evaluation ST. CROIX COUNTY 0 4-k PLANNING & ZONING Dear Homeowner: If you own property that is served by a private on -site wastewater treatment system you are required to provide proper maintenance on this system as per 145.245(3) Wisconsin State Statutes and Chapter 12.7 of the St. Croix County Ordinance. Proper maintenance will help to ensure the longevity of your private sewage system and avoid premature failure. Code Administration 715- 386 -4680 This maintenance program requires inspection of or pumping of the private sewage system at least once every three years at the owner's expense. Inspections may be conducted by a licensed master plumber, licensed journeyman plumber, licensed Land Information & restricted plumber, licensed POWTS maintainer or licensed septic tank pumper. Planning The inspection shall certify that the system is in proper operating condition and the 715- 386 -4674 septic tank is less than 1/3 full of sludge and scum. If the inspection reveals sludge and scum volume to be greater than 1/3 volume of the tank, a licensed septic tank Real Property pumper shall service the tank. The St. Croix County Planning and Zoning 715- 386 -4677 Department is required to track maintenance reporting so your cooperation is greatly appreciated. Recycling 715- 386 -4675 Please return the information below to: St. Croix County Planning & Zoning Department, 1101 Carmichael Road, Hudson, WI 54016. --------------------------------------------------------------------------------------------------------------- ST. CROIX COUNTY SANITARY MAINTENANCE CERTIFICATION FORM System was installed in The private sewage disposal system is in proper operating condition. The septic tank was recently pumped by a licensed septic tank pumper, or it was inspected and is less than 1/3 full of sludge and scum. The effluent filter has been inspected and /or cleaned. All septic systems approved after July 1, 2000 were required to have an effluent filter installed in the septic tank. If your system was approved before this date, you are not required to install a filter, but it is usually recommended. Describe any other maintenance that may have been performed. Signed by: Title: License Number: Date: Signed by Owner: Date: Parcel ID Number: 026- 10 - 90 -020 Property Address or any changes: 1505 HW Y 65 P O BOX 445 Click here to unlock PDFKit.NET St. Croix County Government Center 1. _ I llllll lllll 11111 lllli 11111 lllli llll illlll llil fill CORRECTIVE * 8 5 5 2 8 3 1 rinmimant Nairnhar WARRANTY DEED 85523 This Indenture, made this 22nd day of May. 2007 between Wm. KATHLEEN H. WALSH Derrick Construction, Inc., a Wisconsin Corporation, duly organized REGISTER OF DEEDS and existing under and by virtue of the laws of the State of Wisconsin, ST. CROIX CO., WI located at New Richmond, Wisconsin, party of the first part, and Chad RECEIVED FOR RECORD E. Derrick, party of the second part. 07/10/2007 10 : 30AM Witnesseth, That the said party of the first part, for and in consideration WARRANTY DEED of the sum of to it paid by the said partlga of EXEMPT t 3 the second part, the receipt whereof is hereby confessed and REC FEE: 11.00 acknowledged, has given, granted, bargained, sold, remised, released, Recordina Area aliened, conveyed and confirmed, and by these presents does give, Name and Return Address PAGES! 4- grant, bargain, sell, remise, alien, convey and confirm unto the said parties of the second part, their heirs and assigns forever, the following described real estate, situated in the County of St. Croix State of Chad E. Derrick Wisconsin, to-wit: PO Box 445 THIS CORRECTS THE LEGAL DESCRIPTION IN New Richmond, WI 54017 Sec. 01, T 30 N, R 18 W, Acres: 1.570 #855168 Sec 1 T30N R18W PT NW SW being Lot 6 of CSM 9/2504 1.5TA 026- 1001 -90-020 Township of Richmond, St. Croix County, Wisconsin. (Parcel Identification Number) Seller, Wm. Derrick construction, Inc., a Wisconsin Corporation, is an affiliate of Derrick Homes, LLC. Seller develops land and Derrick Homes, LLC. is a home construction contractor. Seller agrees to sell this lot to Buyer on the condition that Seller's affiliate, Derrick Homes, LLC will be the builder of the home for Buyer. If Buyer does not commence construction With Derrick Homes, LLC as the contractor/builder within two (2) years of the date of sale of this lot to Buyer, Buyer gives Seller the irrevocable right to re- purchase the lot for the same price as Buyer paid Seller for it when Buyer bought it from Seller. If Buyer desires to sell the lot to another purchaser before constructing a home upon the lot, Buyer gives Seller the right of first refusal to re- purchase the lot for the same price as Buyer paid Seller for it when Buyer bought it from Seger. Together with all and singular the hereditaments and appurtenances thereunto belonging or in any wise appertaining; and all the estate, right, title, interest, claim or demand whatsoever, of the said party of the first part, either in law or equity, either in possession or expectancy of, in and to the above bargained premises, and their hereditaments and appurtenances. To have and to hold the said premises as above described with the hereditaments and appurtenances, unto the said partiU of the second part, and to lbgjr heirs and assigns FOREVER. And the said Wm, Derrich Construction. Inc.. party of the first part, for itself and its successors, does covenant, grant, bargain and agree to and with the said pares of the second part their heirs and assigns, that at the time of the ensealing and delivery of these presents it is well seized of the premises above described, as of a good, sure, perfect, absolute and indefeasible estate of inheritance in the law, in fee simple, and that the same are free and dear from all incumbrances whatever, and that the above bargained premises in the quiet and peaceable possession of the said padjU of the second part, their heirs, and assigns, against all and every person or persons lawfully claiming the whole or any part thereof, it will forever WARRANT and DEFEND. In Witness Whereof, the said Wm. Derrick Construction. Inc. party of the first part, has caused these presents to be signed by William H. Derrick, its President, and countersigned by Mary Ann Derrick, its Secretary, this 22nd day of May, 2007. Wm. Derrick Construction:4nc. jr Corporatl a 6 lI William H. erridc President , Mary Ann 'cc Secretary State of Wisconsin, S t. Croix County. Personally came before me, this 22nd day of May, 2007, William N. Derrick, President, and Mary Ann Derrick, Secretary of the above named Corporation, to me known to be the persons who executed the foregoing instrument, and to me known to be such President and Secre o s ' Corporation cknowledged that they executed the foregoing instrument as such officers as the d of said C ra y its a ority. PAMELA RUTLEDGE NOW V Pwwk 8tm Of WiscorMn THIS INSTRUMENT WAS DRAFTED BY Pamela J. Rutled e Wm. Derrick Construction, Inc. Notary Public, W. Croix County S. New Richmond, WI 54017 My commission expires July 2 2 08 1 Of 1 Willow Valley 2M Z54 z 14 18 a 17 16 � � JL! IC ZO IG w t! IG to AG NORTH 24e ��• 13 Lj "AM r 10 11 1 2 tam to Ac u !. „C 360' 25r 2W tit Oet 250' Z r N Q IV 250 a LOT 1 N City of N w Richmond q u Highway 64 a T .5 Willow Valley County Rd. GO j County Road GG 3 (715) 246 -2320 1505 Hwy. 65 D RICK P.O. Box A New Richmond Wisconsin CONSTRUCTIO WILLOW VT p..•�. �d 4w R'�.on1 d,... ZO - d� R� � LOCATED IN PART OF THE NW 1 /4 OF THE SW 114 ST. CROIX COUNTY, WISCONSIN; BEING L07S 7 AN t "`rz"i ` VOLUME 9, PAGE 2504 AT THE ST. CROIX COUNTY ryf CITY OF NEW RICHMOND I _ N 4 X929 N89'52' 23'W 1324.04' 2 7 4 a 4 . LOT 10 S' S A a }' s 16 17 r r 1p o v O w LOT 9 ; e O �Fi 77Y OF N E9 .� - -- -- t0 4�,' — -- a r '�. NEW RICHMOND w -- ROAD - DEDICATED -TO -THE PUBLIC 4Q : z r- `• ✓ 0 LOT 8 I y o / 252 „• —_ _ ;a V 5C 44' / .q - - -- - - - - - -- - - s" HICHVIEW -DRIVE -- ------------ f - - -- 2 o s 10 .szTK n _ 9PrCr. ARK 49 TOP Nt1T F RE - �PA�4- y 9 -S :5 ^a dA '929 I o ,. aC 3 RES LOT i ° ^ - N3.362 so 3 cl i 36' 452.•,. i S89'52'22'E 1323.14 LOT 1 LOT 6 j LOT 1 i LOT 2 [.j - - - C. S. M. 1 C. S. M. I -------- --- -- - - -- I VOL. 5, I C. S. - - M. I - - PC. 1202 - - - - - -- -- VO_L. 9, PC 2504 I cJP DATA ., ------ - - - - -- I NJMBERLOT NO. RAD!US CENT,tAL A 00 n I 1 18 16700 39'08'19" 1 I 2 17 233.00 39'08'19" 3 15 80.00 45'04'10" LOT 2 LOT 5 4 RAN 80.00' 270 ff 00uGUSl s I I - - - - -- 8 15 80.00 7 0 . 25'28" w Lw1 ER s * -2145 I g 14 80.00 48'43'26" 10 t3 80.00 48'43'25" i 1 .1 80.00 48'43' 26" 12 11 80.00 53'32''4" 5 11 80.00 45'04'10" Zrl q$ I 1 5 9 .00 39'08'19" 2 7 9 233.00 39'08''9" • Parcel #: 026 - 1001 -90 -020 12/01/2005 11:59 AM PAGE 1 OF 1 Alt. Parcel #: 01.30.18.10A -20 026 - TOWN OF RICHMOND Current X! ST. CROIX COUNTY, WISCONSIN Creation Date Historical Date Map # Sales Area Application # Permit # Permit Type 00 0 Tax Address: Owner(s): O = Current Owner, C = Current Co -Owner O - WM DERRICK CONST INC WM DERRICK CONST INC 1505 HWY 65 PO BOX 445 NEW RICHMOND WI 54017 Districts: SC = School SP = Special Property Address(es): " = Primary Type Dist # Description / SC 3962 NEW RICHMOND -7 SP 8020 UPPER WILLOW REHAB DIST 3 SP 1700 WITC [ Legal Description: Acres: 1.570 Plat: N/A -NOT AVAILABLE SEC 1 T30N R18W PT NW SW BEING LOT 6 OF Block/Condo Bldg: CSM 9/2504 1.57A Tract(s): (Sec- Twn -Rng 401/4 1601/4) 01- 30N -18W Notes: Parcel History: Date Doc # Vol /Page Type 2005 SUMMARY Bill M Fair Market Value: Assessed with: 0 Valuations: Las Changed: 06/19/2002 Description Class Acres Land Improve Total State Reason RESIDENTIAL G1 1.570 24,900 0 24,900 NO Totals for 2005: General Property 1.570 24,900 0 24,900 Woodland 0.000 0 0 Totals for 2004: General Property 1.570 24,900 0 24,900 Woodland 0.000 0 0 Lottery Credit: Claim Count: 0 Certification Date: Batch M Specials: User Special Code Category Amount Special Assessments Special Charges Delinquent Charges Total 0.00 0.00 0.00 DEPARTMENT OF REPORT ON SOIL BORINGS AND SAFETY & BUILDINGS INDUtTRY', - DIVISION LAB AND PERCOLATION TESTS (115 P.O. BOX 7969 HUMAN RELATIONS �� / �MADI � 370 h W� (H63.09(1) &Chapter 145.045) �Q G�V LOCATION: SECTION: TOWNSHIP /MIft�LITY: LOT NO.: BL . NO.: SUBDIVISION NAME: IN 1145W1/ 1 /T30 N/R18� Richmond 2 n/a n/a COUNTY: OWNER'S NAME: MAILING ADDRESS: [Ji. 54017 3 St. Croix Derrick Const. Inc. 1505 Hy. #65, Ne ond, � USE DATES OBSERVATIONS MADE NO. BEDRMS.: COMMERCIAL DESCRIPTION: PROFILE DESCRIPTIONS: 1PERCOLATION TESTS: Residence 3 n/a �ew ❑Replace 6 -3 -92 n/a RATING: S= Site suitable for system U= Site unsuitable for system CONVENTIONAL: MOUND: IN_ D - PRESSURE: SYSTEM- IN- FILLHOLDING TANK: RECOMMENDED SYSTEM: (optional) US ❑U � ❑U CA - GROUN ❑U I ❑S EW I ❑S HU I conve trench If Percolation Tests are NOT required DESIGN RATE: If any portion of the tested area is in the under s.H63.09(5)(b), indicate: class 2 Floodplain, indicate Floodplain elevation: n/a decimal' PROFILE DESCRIPTIONS p age 28 JS$ BORING TOTAL DEPTH TO GROUNDWATER- INCHES CHARACTER OF SOIL WITH THICKNESS, COLOR, TEXTURE, AND DEPTH NUMBER DEPTH IN, ELEVATION OBSERVED EST. HIGHE TO BEDROCK I F OBSERVED (SEE ABBRV. ON BACK.) B-1 85 100.83 one >85 0 -10, 10yr4/3, L.; - , si ; 24 -53, 7.5yr4/4, S.L.; 53 -85, 10yr3 /4, Co. S. 2 86 100.88 none >86 0 - 12, 10yr4/3, L.; 12 -26, 10yr4 /4, Sil.- B - 26 - 36 7.5 r4/4 s.l.• 36- 86,10yr5/4, L.S. B- 3 88 100.71 none >88 0 -10, 10yr4/3, L.; 10 -20, 10yr , sil.; 20-40- 1 7.5yr S.L.; 40 -88, 10yr5 /4, L.S. B-4 87 100.58 none >87 0 -12, 10yr4 /3,L.; 12 -24, 10yr4 /4, Sil.; 24-57 - _ S B-5 84 100.78 none >84 0 -9, 10yr4/3, L.; 9 -18, 10yr4/4, sil.- B- PERCOLATION TESTS TEST DEPTH WATER IN HOLE TEST TIME DROP IN WATER LEVEL - INCHES RATE MINUTES NUMBER INCHES AFTERSWELLING INTERVAL -MIN. PERIOD t PERIOD 2 PERIOD PER INCH P- P- P- P-_ P_ PLOT PLAN: Show locations of percolation tests, soil borings and the dimensions of suitable soil areas. Indicate scale or distances. Describe what are the hori- zontal and vertical elevation reference points and show their location on the plot plan. Show the surface elevation at all borings and the direction and percent of land slope. SYSTEM ELEVATION 97.25 _ _ M� i { 00 E =r 1 _ . E _w _ E Ste- f E E __________ _ __ __ e_►_ _ _— T _ __ E C 5o 1, the undersigned, hereby certify that the soil tests reported on this form were made by me in accord with the procedures and methods specified in the Wisconsin Administrative Code, and that the data recorded and the location of the tests are correct to the best of my knowledge and belief. NAME (print): TESTS WERE COMPLETED ON: Gary L. Steel 6 -3 -92 ADDRESS: CERTIFICATION NUMBER: PHONE NUMBER (optional): 1554 200th. Ave. New Richmond VTi. 54017 2298 315-2 CST I E: A��Iz�l `7 DISTRIBUTION: Original and one copy to Local Authority, Property Owner and Soil Tester. DILHR -SBD -6395 (R. 02/82) — OVER — INSTRUCTIONS FOR COMPLETING FORM 115 - SBD - 6395 To be a complete and accurate soil test, your report must include: 1. Complete legal description; 2. The use section must clearly indicate whether this is a residence or commercial project; 3, MAXIMUM number of bedrooms or commercial use planned; 4. Is this a new or replacement system; 5. Complete the suitability rating boxes. A SITE IS SUITABLE FOR A HOLDING TANK ONLY IF ALL OTHER SYSTEMS ARE RULED OUT BASED ON SOIL CONDITIONS; 6. PLEASE use the abbreviations shown here for writing profile descriptions and completing the plot plan; 7. MAKE A LEGIBLE diagram accurately locating your test locations. Drawing to scale is preferred, A separate sheet: may be used if desired; 8. Make sure your benchmark and vertical elevation reference point are clearly shown, and are permanent; 9. Complete all appropriate boxes as to dates, names, addresses, flood plain data, percolation test exemp- tion, if appropriate; 10. If the information (such as flood plain, elevation) does riot apply, place N.A. in the appropriate box; 11. Sign the form and place your current address and your certification number; 12. Make legible copies and distribute as required. ALL SOIL TESTS MUST BE FILED WITH THE LOCAL AUTHORITY WITHIN 30 DAYS OF COMPLETION. ABBREVIATIONS FOR CERTIFIED SOIL TESTERS Soil Separates and Textures Other Symbols st - Stone (over 10 ") BR Bedrock col? Cobble (3 - 10 ") SS - Sandstone gr Gravel (under 3 ") LS - Limestone * s - Sand HGV'V - High Groundwater c:s - Coarse Sand Perc - Percolation Rate reed s - Medium Sand W - Vv'eII I's -- Fine Sand Bldg - Building Is Loamy Sand > Greater Than 'sl - Sandy Loam < -- Less Than 'I - Loam Bn -.- Brovvn sii Silt Loam BI Black si - Silt: Gy - Gray cl Clay Loam Y ye1!ovv set - Sandy Clay Loarn R Red sic! - Slaty Clay Loam mot -- I "lottles sc� - Sandy Clay w.' with sic - Silly Clay fff - few, fine, f2Jnt C Clay cc - comn7an, coarse Pt - Pk -'at 11 Many, medium m - Muck distinct p - prornlrwnt 1- WL - High wasta level, Six gerwral soil textures surface rnrater for liquid waste disposal BM -- Bench Mark VRP - Vertical Reference Point TO THE OWNER: This coil test report is the first step in securinc} a sanitary permit. The county or the Departnient may regtaest v( r ificatiorl of this soil test in the field prior to permit issuance. A complete set of plans for the private sevvacge system anti a per nit application must be submimA to the approtiriaw local authority in order to oot.ain a perrnit. The sanitary prrimit must be obt<asi;ed ,in(' pasted prior to the start of any eonstructiorr.